Shutdown dims hope of doc-pay fix, MGMA attendees told

If Congress manages to get the government restarted and avert the debt ceiling crisis, lawmakers may have just enough time to renew their 10-year tradition of "kicking the can" on finding a replacement for the Medicare sustainable growth-rate payment formula.

During a "Washington Update" session, Jeb Shepard and Jennifer Gasperini of the Medical Group Management Association's government affairs staff told attendees at the association's annual conference in San Diego how legislative and regulatory action and inaction may affect the medical practices they run.

"Jeb and I will be offering free hugs after the presentation," Gasperini said, acknowledging that they didn't bring much uplifting news to California.

An SGR-driven 24.4% Medicare pay cut is scheduled to go into effect Jan. 1 unless Congress takes action. Shepard said that hopes for replacement had been high as SGR reform legislation had been approved by the House of Representatives' Energy and Commerce Committee back in July after a new estimate pared the cost of replacing the SGR down to $139 billion over 10 years. A 2012 calculation had put the cost at $245 billion.

"The SGR is effectively on sale and now is the time to act," Shepard said. He added, however, that an SGR stand-alone bill probably wouldn't pass in the current "toxic" environment in Washington and repeal-and-replace legislation would probably need to be part of a larger deficit-reduction package.

Shepard also noted that the CMS should release the final Medicare physician fee schedule for 2014 in the coming weeks—the proposed fee schedule was published in July and the final schedule typically comes in the first week of November.

"But they're not working right now," Shepard said of the CMS staff, so it's anyone's guess when the agency will inform doctors how much Medicare will pay them next year.

Shepard said frustrations were mounting throughout Washington—including in his own household. He said that, if the District of Columbia stops collecting garbage, his wife has instructed him to go dump it on their congressman's lawn.

The audience sided with Shepard's wife. The anecdote was met with applause.